The patch for Autorun is something you should have for reasons I'll explain in a moment. The warning about backing up the registry is CYA stuff. You're supposed to do that when any kind of update is done, and especially those that update critical functions and mess with the registry in significant ways, and this one does. One reason for it is that if your system is in the middle of altering the registry and the power picks that moment to go out, the registry is dead. Or, if your hard drive suddenly has a burp on a critical sector, same thing. There's all kinds of things that can happen. They usually do not happen, but to be on the safer side, MS and anyone giving decent advice will suggest this.
Backing up the registry is not really a big deal. It's just a huge file. Things like Spybot S&D even have a built-in function that does it for you that you can use if you want. A lot of malware removers mess with the registry, and a lot of them have this function. What's often not said, however, is that just backing up the registry doesn't make life wine and roses if something happens. You've still got to restore it, and if your system won't boot because of a registry corruption, you've got to do this at a more basic level. Most people don't know how to do this, and frankly it's been so long since I have I'd be hesitant to tell you how. And here I'm doing a CYA myself. :-)
What the Autorun patch does (the one that was released last year; if there's been another one, I missed it) is correct an error with they way the process gets called that, even if you have Autorun disabled, allows an attacker to use it anyway to infect your system. If you've got Autorun enabled anyway, it doesn't matter quite as much because the autorun.inf file on whatever device/media you load is going to run, and if the nastigram on that media is malware of some sort that's not detected by whatever security tools you have scanning things, you're screwed.
The function of Autorun is merely a convenience. AutoRun/AutoPlay (both terms are used, but they mean the same thing) should, imo, be disabled. The most convenient way to do this is to install
TweakUI, which is a part of MS PowerToys. There's an option in there under MyComputer > AutoPlay that allows you to disable it easily. If the Autorun process is patched and disabled, you shouldn't have any problems. The only inconvenience is that every time you connect external media with an autorun.inf instruction set, load a CD/DVD, etc. you'll have to manually start whatever it is.
All that said, if you're not in the habit of passing around CD/DVDs with others, burning discs you get off torrents, saving things to external drives or USB devices that have autorun functions in them, etc. this is not a huge concern anyway. At least, it's not anymore dangerous than cruising the Internet with a web browser, which is, and for the foreseeable future will remain one of the most common avenues for infection. The trickiest thing I've seen happen is someone having a USB stick hooked up to a computer that is then infected by a virus without the user being aware anything has been written to it, and that virus/whatever uses the autorun process to load itself on every machine to which it is attached every time it's plugged in.
So ... if you can parse that, you can judge your own circumstances.
P.S. And yes, fear is the mind killer. We're afraid of all the wrong things. The anti-malware industry is huge and pulls in hundreds of millions of dollars a year. Hell, it may be billions by now. They work off fear, which is why I call a lot of them a legalized protection racket and also why I point people to free products and suggest giving them a little donation from time to time if you find the authors' products useful. It's a fine line though between instilling too much paranoia and not enough, so I want to make clear nothing I say is meant to suggest the dangers aren't real.