How do I pick my spear back up in Fallout 1?

That could be because it isn't "lootable" from the bodies. You may have to search around with the mouse, walking over every bit of the area that your spear could be in (if indoors, search house). Hope that helps.

EDIT: Can also come back quite some time later, when the bodies have disappeared. Easier to find stuff if bodies isn't covering it (or pools of blood for that matter).
 
Matthews is right. The only thing you can really do is search every pixel and square with your mouse until you find it.
 
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