It is needed to pre-load the headset bearings.
If you don’t have a gap between the top of the steerer and the top of the stem (or spacers on top) then you can’t pre-load the bearings properly and you will get a horrible sloppy headset which will knacker it’s bearing in no time.
There is no way you could manually push down on the stem enough while tightening the bolts to clamp it up to get rid of the headset play.
Technically you could put a long threaded bar down your steerer and use some nuts to preload the bearings and then tighten the stem and remove the rod leaving just a nice hole down through your steerer. But if you headbutt it you might get your forehead apple cored 😀