If you don't offer employees a career path they will leave, especially good ones. Small and medium enterprises also need to attract and keep talent. Hence they need to offer career paths. Those may look different and be broader than in larger organizations but there is no way around offering them - if you want to have sustainable success.
In my opinion, if the management of small companies would like to be a successful company, then they should find the way not only to keep the talent employees, but to attract good professionals and other support staff on board. If the management does not adopt these kind of measures, in most of the cases good professionals and support staff will leave to other enterprises with better working conditions, career paths and good salaries among other benefits.
Most small companies will not be convinced to offer career path to employees, specially the ones which are new. The reason is that they themselves dont know what path the firm will follow and what will be the job hierarchy a few years down the line. However a small company which is relatively old and stable must have a career path to keep the employees excited. One major problem with small firms in general is lack of keenness to delegate which can create hurdles in creating a career path
Based on my experience career paths are especially important for start ups. Since they can in many cases at the beginning not pay as much as established companies it is important to show how people can advance by growing the company.